Provider Demographics
NPI:1033464508
Name:BROWN, MOLLY BAILEY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:BAILEY
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:971 TOMMY MUNRO DR STE D
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2137
Mailing Address - Country:US
Mailing Address - Phone:228-207-1777
Mailing Address - Fax:228-206-7011
Practice Address - Street 1:971 TOMMY MUNRO DR STE D
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2137
Practice Address - Country:US
Practice Address - Phone:228-207-1777
Practice Address - Fax:228-206-7011
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR873896363LP2300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1033464508Medicaid